Insurance and Claims
The abbreviation for health maintenance organization
What is an HMO?
The meteorological beginning of Summer
What is June 1st
The online payment and invoicing system we use
What is Instamed?
The most popular beach destination in Texas
What is South Padre Island?
The portion of a covered medical expense that the insured must pay out-of-pocket before the health insurance begins paying
What is the deductible?
The largest US government-funded insurance plan for ow-income individuals
What is Medicaid?
The day that has the most sunlight and is the longest day of the year
What is the Summer Solstice?
Federal online database used by providers to apply for, update, and manage their unique 10-digit National Provider Identifier
What is NPPES?
This creates black sand at beaches
What is volcanic activity?
The fixed fee paid by the patient for a specific medical service, usually collected at the time of check-in
What is a co-pay?
A formal request sent to an insurance payer to reconsider a denied or underpaid claim
What is an appeal?
The number of hot dogs Americans eat between Memorial Day and Labor Day
What is 7 billion?
A statement sent by the insurance company to the patient explaining what treatments were covered, how much was paid, and what the patient owes
What is an Explanation of Benefits (EOB)?
This beach is the closest to Fort Worth, Texas
What is Galveston Island?
What is the percentage of medical costs a patient must pay after they have met their annual deductible, up to their out-of-pocket maximum
What is co-insurance?
The modifier used when two services are performed on the same day, but neither are an E&M service
What is 59?
National Ice Cream Month
What is July?
This is a list of providers and their identifying information provided to payers we are in contract with
What is a roster?
A dangerous, fast-moving narrow current that can pull swimmers away from the shore
What is a riptide?
The absolute maximum amount a patient will have to pay for covered services in a plan-year before insurance pays 100%
What is the Out-of-Pocket Maximum?
The process of establishing the clinical or medical necessity for specific treatments or procedures before the care is rendered
What is a prior authorization or precertification?
The hottest temperature ever recorded on Earth
What is 134°F?
The form used to complete a background check for Superior Enrollment
What is a 1600 (F-500-1600)?
Natural storm barriers that protect inland areas and re-nourish shores during high waves
What are sand dunes?
A specific type of savings account that allows individuals to put pre-tax money aside to pay for qualified medical expenses, but requires a High-Deductible Health Plan
What is a Health Savings Account (HSA)?